Therapy of portal hypertension using transjugular intrahepatic portosystemic shunt – first 1,000 procedures in UH Hradec Kralove
Authors:
A. Krajina 1; P. Hůlek 2,3; Miroslav Lojík 1; V. Chovanec 1; O. Renc 1; J. Raupach 1; T. Fejfar 2; V. Jirkovský 2; V. Šafka 4; Š. Šembera 2; T. Vaňásek 2
Authors‘ workplace:
Radiologická klinika LF UK a FN Hradec Králové
1; II. interní gastroenterologická klinika LF UK a FN Hradec Králové
2; Interní klinika LF OU, Ostrava
3; Ústav fyziologie, LF UK, Hradec Králové
4
Published in:
Gastroent Hepatol 2014; 68(2): 100-107
Category:
Hepatology: Review article
Overview
Transjugular intrahepatic portosystemic shunt (TIPS) has been available for clinical practice since 1989, and in the Czech Republic since 1992. It is mostly used in patients suffering from liver cirrhosis and related complications such as GI bleeding or large ascites. In fact it is a side-to-side portacaval anastomosis reinforced with a metal stent and created by interventional radiologist without surgery. In the course of the 25 years of its clinical use, some changes have occurred: more than one-third of patients suffer from hepatic encephalopathy, but treatment with rifaximin is successful in most of them. The bare stent used for TIPS in the initial period, having a much higher risk of patency problems, was replaced by a covered stent (stent-graft). Though many indications were specified, some others still await confirmation, e.g. indication of TIPS according to the portacaval gradient. In the latest period, the number of indications for GI bleeding is decreasing, but the number of procedures for ascites and hydrothorax, having more altered liver functions, is rising. TIPS reduces portal pressure but does not improve liver function, so it cannot substitute liver transplantation. TIPS is performed by an interventional radiologist, but cooperation with the hepatologist is a fundamental condition for good treatment of patients. For the time of its existence, TIPS has established a firm position in the therapeutic portfolio of portal hypertension complications.
Key words:
liver cirrhosis – portal hypertension – transjugular intrahepatic – portosystemic shunt
The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.
The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.
Submitted:
24. 2. 2014
Accepted:
17. 3. 2014
Sources
1. Rösch J, Hanafee WN, Snow H. Transjugular portal venography and radiologic portacaval shunt: an experimental study. Radiology 1969; 92(5): 1112–1114.
2. Richter GM, Palmaz JC, Nöldge G et al. The transjugular intrahepatic portosystemic stent-shunt. A new nonsurgical percutaneous method. Radiologe 1989; 29(8): 406–411.
3. Hůlek P, Krajina A. Current practice of TIPS. Hradec Králové: Olga Štambergová 2001.
4. Krajina A, Hulek P, Fejfar T et al. Quality improvement guidelines for transjugular intrahepatic portosystemic shunt (TIPS). Cardiovasc Intervent Radiol 2012; 35(6): 1295–1300. doi: 10.1007/s00270-012-0493-y.
5. Bureau C, Garcia-Pagan JC, Otal P et al. Improved clinical outcome using polytetrafluoroethylene-coated stents for TIPS: results of a randomized study. Gastroenterology 2004; 126(2): 469–475.
6. Hanafee W, Weiner M. Transjugular percutaneous cholangiography. Radiology 1967; 88(1): 35–39.
7. Rösch J, Hanafee W, Snow H et al. Transjugular intrahepatic portacaval shunt. An experimental work. Am J Surg 1971; 121(5): 588–592.
8. Gutierrez OH, Burgener FA. Production of nonsurgical portosystemic venous shunts in dogs by transjugular approach. Radiology 1979; 130(2): 507–509.
9. Reich M, Olumide F, Jorgensen E et al. Experimental cryoprobe production of intrahepatic portocaval shunt. J Surg Res 1977; 23: 14–18.
10. Burgener FA, Gutierrez OH. Production of an intrahepatic portocaval fistula in the dog with liver cirrhosis and portal hypertension. Rofo 1984; 141(3): 327–332.
11. Colapinto RF, Stronell RD, Birch SJ et al. Creation of an intrahepatic portosystemic shunt with a Grüntzig balloon catheter. Can Med Assoc J 1982; 126(3): 267–268.
12. Burgener FA, Gutierrez OH. Experimental intrahepatic portocaval shunts created in portal hypertension by balloon angioplasty catheters. Invest Radiol 1988; 23(1): 24–29.
13. Colapinto RF, Stronell RD, Gildiner M et al. Formation of intrahepatic portosystemic shunts using a balloon dilation catheter: preliminary clinical experience. Am J Roentgenol 1983; 140(4): 709–714.
14. Gordon JD, Colapinto RF, Abecassis M et al. Transjugular intrahepatic portosystemic shunt: a nonoperative approach to life-threatening variceal bleeding. Can J Surg 1987; 30(1): 45–49.
15. Palmaz JC, Sibbitt RR, Reuter SR et al. Expandable intrahepatic portacaval shunt stent: early experience in the dog. Am J Roentgenol 1985; 145(4): 821–825.
16. Palmaz JC, Garcia F, Sibbitt RR et al. Expandable intrahepatic portacaval shunt stents in dogs with chronic portal hypertension. Am J Roentgenol 1986; 147(6): 1251–1254.
17. Rösch J, Uchida BT, Putnam JS et al. Experimental intahepatic portacaval anastomosis: use of expandable Gianturco stents. Radiology 1987; 162(2): 481–485.
18. Krajina A, Hůlek P, Eliáš P et al. Transjugulární intrahepatický portosystémový zkrat. Cor Vasa 1993; 35(4): 157–161.
19. Krajina A. Dvacetiletá historie TIPS v Hradci Králové. Ces Radiol 2013; 67(2): 105–108.
20. Krajina A, Hůlek P, Eliáš P et al. Transjugulární intrahepatální portosystémový zkrat (TIPS) při léčbě symptomatické portální hypertenze. Čas Lék Čes 1996; 135(18): 584–588.
21. Zizka J, Eliás P, Krajina A et al. Value of Doppler sonography in revealing transjugular intrahepatic portosystemic shunt malfunction: a 5-year experience in 216 patients. Am J Roentgenol 2000; 175(1): 141–148.
22. Krajina A, Lojik M, Chovanec V et al. Wedged hepatic venography for targeting the portal vein during TIPS: comparison of carbon dioxide and iodinated contrast agents. Cardiovasc Intervent Radiol 2002; 25(3): 171–175.
23. Pozler O, Krajina A, Vanicek H et al. Transjugular intrahepatic portosystemic shunt in five children with cystic fibrosis: long-term results. Hepatogastroenterology 2003; 50(52): 1111–1114.
24. Krajina A, Lojik M, Chovanec V et al. Stent-grafts in TIPS. Abdom Imaging 2004; 29(1): 53–59.
25. Jirkovsky V, Fejfar T, Safka V et al. Influence of the secondary deployment of expanded polytetrafluoroethylene-covered stent grafts on maintenance of transjugular intrahepatic portosystemic shunt patency. J Vasc Interv Radiol 2011; 22(1): 55–60. doi: 10.1016/j.jvir.2010.09.016.
26. Fejfar T, Šafka V, Hůlek P et al. MELD skóre v predikci časné mortality u nemocných s refrakterním ascitem léčených pomocí TIPS. Vnitř Lék 2006; 52(9): 771–776.
27. Boyer TD, Haskal ZJ. The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension: update 2009. Hepatology 2010; 51(1): 306. doi: 10.1002/hep.23383.
28. Runyon BA. Management of adult patients with ascites due to cirrhosis: an update. Hepatology 2009; 49(6): 2087–2107. doi: 10.1002/hep.22853.
29. Harrod-Kim P, Saad WE, Waldman D. Predictors of early mortality after transjugular intrahepatic portosystemic shunt creation for the treatment of refractory ascites. J Vasc Interv Radiol 2006; 17(10): 1605–1610.
30. Strauss RM, Boyer TD. Hepatic hydrothorax. Semin Liver Dis 1997; 17(3): 227–232.
31. Rössle M, Haag K, Ochs A et al. The transjugular intrahepatic portosystemic stent-shunt procedure for variceal bleeding. N Engl J Med 1994; 330(3): 165–171.
32. Renc O, Krajina A, Hůlek P et al. Dlouhodobá průchodnost transjugulární intrahepatální portosystémové spojky (TIPS) u nemocných s trombózou jaterních žil. Ces Radiol 2013; 67(2): 109–120.
33. Senzolo M, Cholongitas E, Davies N et al. Transjugular intrahepatic portosystemic shunt (TIPS), the preferred therapeutic option for Budd Chiari syndrome associated with portal vein thrombosis. Am J Gastroenterol 2006; 101(9): 2163–2164.
34. Lojík M, Krajina A, Vaňásek T et al. Embolizace krvácejících varixů při portální hypertenzi u TIPS – vlastní zkušenosti a literární přehled. Čes Radiol 2002; 56(3): 188–192.
35. Stankovic Z, Frydrychowicz A, Csatari Z et al. MR-based visualization and quantification of three-dimensional flow characteristics in the portal venous system. J Magn Reson Imaging 2010; 32(2): 466–475. doi: 10.1002/jmri.22248.
36. Azoulay D, Castaing D, Dennison A et al. Transjugular intrahepatic portosystemic shunt worsens the hyperdynamic circulatory state of the cirrhotic patient: preliminary report of a prospective study. Hepatology 1994; 19(1): 129–132.
37. Maleux G, Nevens F, Heye S et al. The use of carbon dioxide wedged hepatic venography to identify the portal vein: comparison with direct catheter portography with iodinated contrast medium and analysis of predictive factors influencing level of opacification. J Vasc Interv Radiol 2006; 17(11 Pt 1): 1771–1779.
38. Carr CE, Tuite CM, Soulen MC et al. Role of ultrasound surveillance of transjugular intrahepatic portosystemic shunts in the covered stent era. J Vasc Interv Radiol 2006; 17(8): 1297–1305.
39. Riggio O, Angeloni S, Salvatori FM et al. Incidence, natural history, and risk factors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt with polytetrafluoroethylene-covered stent grafts. Am J Gastroenterol 2008; 103(11): 2738–2746. doi: 10.1111/j.1572-0241.2008.02102.x.
40. Bass NM, Mullen KD, Sanyal A et al. Rifaximin treatment in hepatic encephalopathy. N Engl J Med 2010; 362(12): 1071–1081. doi: 10.1056/NEJMoa0907893.
41. Rössle M, Siegerstetter V, Euringer W et al. The use of a polytetrafluoroethylene-covered stent graft for transjugular intrahepatic portosystemic shunt (TIPS): long-term follow-up of 100 patients. Acta Radiol 2006; 47(7): 660–666.
42. Rössle M, Ochs A, Gülberg V et al. A comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites. N Engl J Med 2000; 342(23): 1701–1707.
43. Salerno F, Camma C, Enea M et al. Transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis of individual patient data. Gastroenterology 2007; 133(3): 825–834.
44. Michl P, Gülberg V, Bilzer M et al. Transjugular intrahepatic portosystemic shunt for cirrhosis and ascites: effects in patients with organic functional renal failure. Scand J Gastroenterol 2000; 35(6): 654–658.
45. Garcia-Pagán JC, Caca K, Bureau C et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med 2010; 362(25): 2370–2379. doi: 10.1056/NEJMoa0910102.
46. Garcia-Pagán JC, Heydtmann M, Raffa S et al. TIPS for Budd-Chiari syndrome: long-term results and prognostics factors in 124 patients. Gastroenterology 2008; 135(3): 808–815. doi: 10.1053/j.gastro.2008.05.051.
47. Barton RE, Rösch J, Saxon RR et al. TIPS: short- and long-term results: a survey of 1750 patients. Semin Interv Radiol 1995; 12: 364–367.
48. Krajina A, Hulek P, Ferko A et al. Extrahepatic portal venous laceration in TIPS treated with stent graft placement. Hepatogastroenterology 1997; 44(15): 667–670.
49. Stefánková J, Hůlek P, Babu A et al. Hepatic encephalopathy due to TIPS – retrospective study. Hepatogastroenterology 2007; 54(74): 480–484.
50. Riggio O, Ridola L, Lucidi C, Angeloni S. Emerging issues in the use of transjugular intrahepatic portosystemic shunt (TIPS) for management of portal hypertension: time to update the guidelines? Dig Liver Dis 2010; 42(7): 462–467. doi: 10.1016/j.dld.2009.11.007.
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Paediatric gastroenterology Gastroenterology and hepatology SurgeryArticle was published in
Gastroenterology and Hepatology
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